TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 2JCP3(C > Date: "^/ll/o? 

Address 

Remediation Contractor: _Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

0y, Executive Summary 

^ EPA-provided property sketch 

j ^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

\f^ Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

1^ Confirmation data 

^ Photographs 

^ As-built sketch 

5^ Satisfactory restoration signed by Property Owner 

1^ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

a, 
Property Access Checklist 

PropertylD: ^/(^^^{ ^ 

Property Addrcs.s: 5^/^ / /UC(5V7 l 

n

D

 WOKK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner:

Address: 

 fX)l/l/ai ] SfnUJf J f Renter: 

Phone: 

Phone:

Fax: 

 }^ % ^376 7 

Fax: 

Cell/Pager: 

Additional Information: 

Ccll/Pascr: 

D Noi ification Letter 

[ S Access Aj:;reenient 

NJ Restoration Agreement 

C] Topsoil Sampling (ifaitplicahle) 

LJ Disposal Saniplinf; (if applicable) 

IZ! Ganlen Samplin); (ifapplicable) 

[^ Utility Clearance 

^ Video/Photos (Before) 

n Video/Photos (Durin;;) 

D Video/Photos (After) 

D Video/Photos (3()-Day) 

1 1 Properly Completion Agreement 

1 1 Final Report 

Sent: / / 

Signed: j2./<^//_ ^ 

Signed: 5" 1 991 _CJ 

1 1 

1 1 

1 1 

Called: _^/^/(2 1 

On: ^1^117 2 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

^r-lU(AtC01) 

^r7Aano5 

By: 

By: 

By: 

^yy7risK7^ 

^y-l(jc7\ 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

1 CH Community O Crew 

Results: 

On: / / By: 

CH Community

1 Results: 

 CH Crew On: / / By: 

CH Community

Results: 

 CH Crew On: / / By: 

Omaha Lead Site 
Q^^ant Square Footage to be Excavated = 307 h 

Property Classification: 800 a^ B Zone Linear Footage to be Excavated = 98 

Desaiption of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard light-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
^$D-ini h^ (f^' 

Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

^K.^ U 

:^MK /n^<.^., 

 Date:_x ^^p-t Time: iMij? Action: LtP^ (o^ccU. .^^ 

 Date:^ ^S Time:t|^fK Action:/:^^ f.b j/^ f IM^g. 

 Date: Time: Action: 

Transmit to EPA D Other Action: O 
,-^^^"J:'^'... 

'•»( ,.HO-V* ^ 

Consent For Access To Property 

RIGHT OF EN TRY IO PRI'MISIVS 

Grantor (the property owner) consents to and authorizes the United States Environmental 

Protection Agency (EPA) or its authorized representatives, collectively the Grantee, to 

enter and perfonn certain environmental response activities upon the following described 

premises: 

Owner's Name: 

Daytime Phone: 

Address: ^^^ ^ ^^^ ^ 

Address: 

Addresses of 

Propertie Address: s covered by 

this Agreement: Address: i i 

Address: 

PuRPosi;Ol- Ri'SPONSi; Aciivrriivs 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of arsenic and/or lead and may pose a health hazard. The soil 

will be removed and the e.xcavated area(s) will be replaced with clean materials and 

restored. This work is being performed under the Omaha Lead Site Superfund Site 

remediation program. 

An EPA representative will contact the Grantor in-person to discuss the work to be 

performed, the Grantor will have an opportunity to review and approve the planned soil 

removal, and restoration work before it begins. Once the work is finished, the Grantor 

will be asked to review the work and confirm that it is complete and meets with the 

Grantor's approval. Upon completion, the Grantor will receive written documentation 

from EPA that the property has been remediated. 

ENVIRONMI'NTAI. RivSPONsi; ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times and 

with prior notice, for the sole purpose of performing the work. This access shall remain 

in effect until the work has been satisfactorily completed. The Grantor also agrees to: 

Pag «Property_ID» e 1 of2 
•-Ww^ 

• Remove obstmctions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work if EPA is unable to obtain such access; and 

• Allow videotaping and/or photography of the property including exterior and 

1/^ -interior areaa ofbuildings. 

Ac.Rf:i':Mi-:N T Nor To INTI-:RFI:RI: 

The Grantor agrees not to interfere or tamper with any ofthe activities or work done, or 

the equipment used to perform the activities, or to undertake any actions regarding the 

use of said property which would tend to endanger the heahh or welfare of the Grantees 

or the environment, or to allow others to use the property in such a manner. 

Should you have any questions about this program, please contact 

0 4 grant access to my properties D > do not grant access to my properties 

TA^h ^ 

Signature Date Signature Date 

LJ 1 would like to be present during any sampling that is required. 

Page 2 of 2 

«ProDeitv ID: 
Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of property prior to 

remediation activities. This will also serve as decontamination for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Environmental Protection Agency (EPA). 

PropertylD: ^//^^ O 

Property Address: S^i^ /HaSOil -SV" 

P'^""^^ ^^i/>-3i31 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of_ (. 
'4=--

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

iit^ ?Z(lo^^t S'id^ i QmS 7 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. G 
^^^f » 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of ^ 
VV! 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area 

that is covered wilh grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Numbei- of Sprinkler 

Zones, ConU'ol Valves, 

•fimers, Heads, etc. 

Allaeh a sketch t>f the 

sprinkler la\x)iil. 

Number of and size of 

each garden/ flower bed 

area. 

Allacii a skeleh of relative 

si/es and locations. 

Quantity Unit Condition/Type/Specles 

tfoC Square feet 

0 fiach 

• 

7) 

i 

Each 

0 luich i 

f'ach 

Square Feet 

i 

j 

Page 4 of (/> 
IV 

Item 

Agreed ujion value of 

jilant malerials nol lo be 

rejilaced bv contractor. 

Note this \alue will he 

used lo issue a planl 

x'ouehcr lo the jiropei"l\ 

owner 

Agreed upon list of plant 

malerials lhal will be 

replaced by contractor. He 

veiy specific and detailed. 

Include a skeleh of were 

each plant will be jilaeed 

In llic ccmliacUir, 

Agreed u|-)on area of 

projierly to be replaced 

wilh grass st)d. 

Inelude a skeich ol' the 

area(s) lo be replaced with 

grass sod. 

Area of Cily or Couniy 

propeily lo he landscaped 

per their requiremenis. 

Include a skeleli of the 

area (s) 

Quantity Unit 

$ 

Condition/Type/Species 

/hAA-A^ f^lAjI 7^/ ^ 

liach 

k^ SF 

SF ' 

Page 5 of v> 
Additional Comments / Instructions: 

s ^ / CA ^ i^^^f y^ ^ 

• Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

SfC agree n I do not agree D l agree n I do not agree 

5^p9^^7 

Ovvner's Sijrnature Date Contractor's Signature Date 

Page 6 of ( j 
ID#:

Date:

Name:

 ZH^BL 

 ^|i3|o% 

 JC.'c k V . 

Description: 

Ha s £ >^ W StC-l-c^ oP S C Co^i^UL 
-RCFEPTV C:=AKiNCH vVCPKS'-£E~ )^-. 

Date 

Property ID fhirQjfA 

AlllSU: 

Property Project Omaha Lead -- Fixed Price Address A\\9 M^s^^r 

Measurement XRF ID OlOl- 51 

Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # 

-7g/. 

17. 1?-(M" 

T^g 

T57. \7-(MSample

 Area F>\ a-m' ' 

I n Situ 

Composite Aliquot 

Composite Readings Reading 

.Average (Bag) (Bag)

IK 

_^9-

34 -§t .2_ XRF Corrected Value --> it^ 

13 (use calibration chart o- icC 

ZC-Zc tc value) 

Sample Area TT?

 /?-(U- I n Situ 

Zomposite i^iiajc t 

Ccrpcsit e Re.^c:rc« Readino 

Average (Bag) (Bag)

^ ^ T ^ = 

ZIO 

\o\ XRF Corrected Value --> 

(use calibratior. chart or ace cSbi 20'^c tc value) 

Sample Area I B7 )7-m " 

I n Situ 

Composite Aliquot 

Composite Readings 

Readjng 

Average (Bag) :mi (Bag)

-^[2. 

e-13 QS I il 94 

-^g- I Z 

I XRF Corrected Value --> 49 

|(use calibration chart or add 

'20% to value) \\ $ 

Sample Area { 

I n Situ Composite Aliquo t 

Composite Readings Reading 

Average (Bag) 1 (Bag)

Confidential 

Reading Sample Area 

Pass/Fail ? 

 Composite Analytical 

Lab Analytical (Dried & Spilt Sent Number ReSiJits I Sieved) 7 

Pass/ Fail 

 Ccmposite Anaiytical 

Lab 'Dried & Spitt Sent Nwmber 

i Sieved) ! ? 

Pass/Fail ? 

 , Composite jAnsIytical 

Lab i Anaiytical 

j (Dried & Split Sent Numberi Results 

: Sieved) ' 

Pass/Fail ? 

 Composite Analytical Lab Analytical (Dried & Spilt Sent Number Results •> Sieved) 

-see ­

1 
3 ! 

4 ^ ^ 

5 

XRF CiBHbed Value ~ > 

(use calTbraticn chart or add 

2 0% to value) 11

! ,| • I 

Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent Lab 

Number 

Analytical 

Results 

2 

3 

4 

XRF Corrected Value —> 1 ! 1 

(use calibration chart or add 

... .. . 2 0% to value) 

X*<,p .sc*".P'C'2'' O « . .1 ,.u 

v\/Ali J^T^ 

Confidential 
I

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

^ < #

www. coastal hazm at. com 

COASTA L INVmONMENTi l 

CROUP . INC . 

EXECUTIVE SUMMARY: 

21686—3419 MASON STREET 

 I No Issues or Concerns Issues/Concerns 

Detail Explanation: 

Property Owner was issued a gift certificate in the amount of $100.00 for bushes and shrubs removed 

during excavation. 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Ouadrant Square Footage to t>e Excavated = 307 

Property Classiticatton: 800 Total Dfip Zone Linear Footage to be Excavated = 98 

t^Mason Street 

North Arrow Omah a Lea d Site 

Omaha. Nebraska Legend g^s^-jieg i 

i^^ Dat^Excavated:6/9/07 

Property Number Date USEPA Signed Off:7/2/07 OLS-21686 

Scale Property Address Permarwnt Landscaping 1 Inch = 20 feet or 1 grid = 5 x S ft 3419 MASON ST • •— • Fence 

— — — Quadrant Boundary Post Excavation Concentrations (ppm) 

Stree Fl . 82 Play Area t Boundary t 5 gB;g.­ F2 DZ Easement 

<Q) Tree/Shrub B1 Garden Other 

D«sct^Kvi af posl «KC«V<IIK3(I «f«as F1. (rani yard lnn.|iand quadrar^. F2. fiont yard righl-hand quadrant B1. bacityard l«ft-hand quBdrap-it. B2. backyard nghl-hartd quadrant 

DZ. ik v zone <1'3 foci aroa of sort around tfw foundatton of itw house) 

Legend 

Area not Excavated 
 Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
m^ 

Property Completion Agreement 

This agreement documciUs tlic completion of remedial activities perfonned on my property. My 

signature will dcsignalc that i am satisfied with tlic restoration of my properly, and lhal no ilcms arc in 

questions, now. or al any lime in ihc fulurc, except those ilcms listed below, if any. 

Property ID: ^/[/^( ^ 

Pr<,pcrtv Adilrcss: ^4/ ^ H IgSQTl SJOwner: LUi///7iiyi Sf/)LUlU 

Phone: V^^ -.^/^^ -ni i^a> in i 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

\Qi\iv.i iicrc­ c i-estoration is completed, except HS noted 

 I I do not agrcc-restoration is completed 

i1 ^ 7 0~7-f~ 

Date 

I
Omah a Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner '\l\/\iimM ^i:DW^u 

Property Address Ml ^ ^^7^ ^ ^ -

Property Identiflcation Number i^m 

Material Removed Replacement Value 

Flower bed area 

Trees 

Itemized 

shrubs/bushes 470 " 

Total O V ^ 

The acceptance of the replacement certificate and the signature below is full 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ [ has been received by the owner iir the form of a gift 

certificate, # '^V^ . to be utilized at \n\7lf^A (T^ y y\y[7y^\ ^. 

/lf?^^nAM7 ^_3/is7)i_ Property Owner's Signature Date Contractor's Signature 
INDIAN CREEK NURSERY 2530 

Omaha's Best Kept Gardening Secret 

303 North Saddle Creek Road 

Omaha, Nebraska 68131*2229 

(402) 558-5900 Gift Cer ificate 

PATE 

IN THE AMOUNT OF: 

ISSUED TO : }jJjJi\nfyi ^OLMJ I COMPLIMENTS ov.CDashJ Sic/, 

EXPIRATION DATE: ^ ~<iO "^Oo J J. \AJ 

A Authorized Signature 
SEPA i A Property Close Out For rf 

Property #: ^M^ Property Addre«: ^4l^/UOSO ^ S^ -

Datc/TlBc: Owner's Name: /Al/llA/r i ^WlM/ l 

Quads Excavated: Contractor Group 

ExcavatioB Gencrsl Yrt No 

I. If nccessa.'y, were the correct quadrant(s) excavated and restored? ^ 

2. If ncccssaty, were the correct areas of drip zone excavated Jind restored*] 

Grading Sod and VetetotioB Yes No 

1. Does the grading around the perimeter ofthe house ir excav ated areas generally slope away y from the bouse? 

2. Has sod been laid Ln all areas that were excavated? 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

i / day time period) 

4. .\re sodded areas generally firm and evenly graded? 

Arc the jcLnts between the sod strips generally tight? (Only e\ aloate if inspected at z !-0 day 

time period) ^<Jv>v<- V^-^ '^2." , ^ jT^k . (fStT fjKvic/^) 

6. Was the property graded such that w ater \^ ill not pool or. the prope'TN ? y ^ 

7. ^'as damage to landscaping or plant maieriEls a<. cidec? 

Gaicv, Peaces aas RciainiDf '^aib Ves No 

'.. Do gates open and close freely" (Ifapplicable) AAA2. Were all gates or fences laken dowit during restoration acti\ ities reir.: '^!!e-c? ..Tapplicabit^)! 

3. Was damage to gates or fences avoided? (Ifapplicable) /^K 

4. Was damage tc retabir.g walls avoided? i,!f applicable) /r>^ 

Foundation, Sidisg and Gutters Ves Nc 

1. Was damage to the siding or trim avoided? 7 

2. W ^ damage to the foundation avoided? y 

3. Was damage to windows avoided? ^ 

4 Was damage to windows or door screens avoided? ^ 

5. Was damage to downspouts or downspout extensions avoided? <„.-

Sidewalks and Drtveways (Concrete) Ves No 

I. Was damage to driveway surfaces avoided? /i/A 

2. Was damage to wallcway surfaces avoided'; y 

1 
Owners comments: 

Inspection nctes: 

-/- ^^J<- c)f iJ^/e r d /n&nc /or so J. h.^^^^/ ^ iyJ^ ^ 

Remc\'al and restcration acth ates corr.p'ete including the 30-day sod -v*.arrant}": 

EPA Represer. Date: 77jAy7£? y